Health Advisory
SECOND CONFIRMED INFLUENZA CASE FOR 2008-2009

Delaware

The Delaware Division of Public Health (DPH) is reporting the state's second laboratory confirmed case of influenza. The case is a 26 year-old female from New Castle County who was evaluated in the emergency department and released to home. This case is Type A influenza and was confirmed at the DPH laboratory by PCR (polymerase chain reaction) on November 3rd.

In addition to laboratory testing, DPH conducts surveillance for influenza by monitoring the occurrence of influenza like illness (ILI) in all hospitals and selected long term care facilities, large corporations and stand alone medical clinics. Reports are provided to DPH weekly. ILI is fever equal to or greater than 100 degrees F, oral or equivalent, and cough and/or sore throat, in the absence of a known cause). ILI activity has not increased so far this year. Nor have reports of respiratory symptoms among patients seen in Delaware's emergency rooms, also reported to DPH weekly.

National

During week 44 (October 26-November 1, 2008), a low level of influenza activity was reported in the United States. Eleven (0.6%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories were positive for influenza. The proportion of deaths attributed to pneumonia and influenza was below the epidemic threshold. The proportion of outpatient visits for influenza-like illness (ILI) and acute respiratory illness was below national baseline levels. Fifteen states, the District of Columbia, and Puerto Rico reported sporadic influenza activity; 35 states reported no influenza activity. National information can be found at: http://www.cdc.gov/flu/weekly/index.htm

Vaccine Availability

A DPH clinic schedule can be found here: http://www.dhss.delaware.gov/dph/fluclinics.html

In general, anyone who wishes to reduce their chances of getting the flu may be vaccinated. However, the CDC recommends that people who are at high risk of having serious flu complications or people who live with or care for those at high risk for serious complications should be vaccinated. Those at high risk for serious complications of flu include:

• Children aged 6 months up to 19th years
• Pregnant women
• People 50 years of age and older
• People of any age with certain chronic medical conditions
• People who live in nursing homes and other long-term care facilities
• People who live with or care for those at high risk for complications from flu, including:
  1. Health care workers
  2. Household contacts of persons at high risk for complications from the flu
  3. Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)

A comprehensive schedule can be found at this website: http://www.flucliniclocator.org/

Testing

The Delaware Public Health Laboratory (DPHL) performs a Real Time Reverse Transcriptase Polymerase Chain Reaction (Real Time RT-PCR) method for detection of influenza virus nucleic acids. The data generated by Real Time RT-PCR will help determine what influenza viral types are circulating in Delaware, and the most appropriate treatment to provide to patients. Results are available within 48 to 72 hours depending on the number of specimens received. RT-PCR has the ability to detect non-viable viral particles and provides optimal sensitivity and specificity for identification of influenza. Furthermore, PCR can distinguish the common human strains of influenza virus (H1, H3) from uncommon strains (H5 and H7).

DPH strongly encourages health care providers to submit influenza specimens to the DPH Laboratory for PCR testing and subtyping (throat/NP/nasal wash) to assist with surveillance. Influenza testing by the DPH Laboratory is done free of charge and results are sent back to the requesting physician or hospital as soon as test results are available. To submit a specimen contact the DPH laboratory (302-223-1520) to request influenza virus detection kits and obtain information about specimen transport to the laboratory.

For More Information

• DPH Laboratory: (302) 223-1520
• DPH Immunization Hotline: 1-800-282-8672
• DPH Epidemiology: 1-888-295-5156
• CDC Influenza Website: http://www.cdc.gov/flu/about/disease.htm
• Vaccination Resources for Health Care Professionals: http://www.cdc.gov/flu/professionals/vaccination/
• Antiviral Medications for Influenza: http://www.cdc.gov/flu/professionals/treatment/
• Patient and Provider Education: http://www.cdc.gov/flu/professionals/patiented.htm
• Clinical Description and Diagnosis: http://www.cdc.gov/flu/professionals/diagnosis/
• Lab Diagnosis: http://www.cdc.gov/flu/professionals/diagnosis/
• Influenza Information for Health care Professionals: http://www.cdc.gov/ncidod/dhqp/id_influenza_vaccine.html
• Control of Influenza in Acute Care facilities: http://www.cdc.gov/flu/professionals/infectioncontrol/healthcarefacilities.htm